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General NPI Number Information
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NPI Number | 1598418170
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Entity Type | Individual
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Provider Name | CHRISTOPHER RYAN BERTIAUX MA, LPC, LAC, NCC
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Gender | Male
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Dates
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Enumeration Date | 02/02/2022
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 285 PARK AVE APT 4306
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City | POOLER
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State | GA
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Zip | 31322-4223
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Country | US
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Telephone | 843-321-7881
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Fax |
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Provider Business Mailing Address
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Address Line | 285 PARK AVE APT 4306
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City | POOLER
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State | GA
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Zip | 31322-4223
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Country | US
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Telephone | 843-321-7881
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 9636
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License Number State | SC
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